Diagnostics order on invoice

1. Patient / Invoice Recipient

First Name *

Last Name *

Date of Birth *

Email *

Phone / Mobile

Street / House number

Postal Code / City

2. Where should the blood-collection kit be sent?

Patient / Invoice Recipient Practice / Clinic / Physician

Practice / Clinic name *

Physician / Contact person

Street / House number *

Postal Code / City *

Practice / Clinic phone

Practice / Clinic email

Additional shipping instructions

3. Select diagnostics

You can select a predefined package and add individual tests.

Immune Status TBNK – €728.94 CTC / Tumour Count – €542.19 Oncology Basic – €1,271.13 Monitoring – €2,355.50 Oncology Plus – €1,894.45 DCT included – €0 additional Individual Tests Only

DCT Included: A current IMMUMEDIC DCT treatment contract is required. 2× immune status checks and 3× tumour count/tumour dynamics measurements are then included in the agreed treatment price.

Immune Status & Tumour Dynamics

Immune Status TBNKEDTA 2,7 ml 728,94 € CTC / Tumour CountEDTA 9 ml completely filled 542,19 €

Inflammation / Stress

Inflammation/Stress Profile (Ferritin + Cortisol + IL-6)Z-Gel 7,5 ml 283,14 € FerritinZ-Gel 7,5 ml 98,83 € CortisolZ-Gel 7,5 ml 104,06 € IL-6Z-Gel 7,5 ml 155,25 €

Vitamins

Vitamin B12Z-Gel 7,5 ml 98,90 € Active B12Z-Gel 7,5 ml 193,63 € Vitamin DZ-Gel 7,5 ml 146,56 €

Thyroid

Thyroid Profile (TSH + fT3 + fT4)Z-Gel 7,5 ml 275,29 € TSHZ-Gel 7,5 ml 129,26 € fT3Z-Gel 7,5 ml 129,26 € fT4Z-Gel 7,5 ml 129,26 €

Tumour Markers / Additional Oncological Diagnostics

Prostate – PSAZ-Gel 7,5 ml 100,60 € Breast – CA 15-3Z-Gel 7,5 ml 111,64 € Pancreas / Biliary Tract – CA 19-9Z-Gel 7,5 ml 113,18 € CEA – depending on the clinical questionZ-Gel 7,5 ml 97,46 € Ovary – CA 125Z-Gel 7,5 ml 115,20 €

Infectious-Disease Serology

HIV DuoZ-Gel 7,5 ml 105,48 € HBsAgZ-Gel 7,5 ml 95,40 € Anti-HBcZ-Gel 7,5 ml 90,91 € Anti-HCVZ-Gel 7,5 ml 138,05 €

4. Blood Collection & Shipping

Bloedafname

Shipping Kit

5. Medical Information

Diagnosis / Clinical Question

Previous / current treatment

6. Order Confirmation

Send an order confirmation with order number and PDF summary to my email address.

If a practice/clinic is specified as the kit recipient, an additional shipping-only confirmation may be sent there. Medical information is not included in this practice copy.

7. Order, Terms & Privacy

I have read the Algemene voorwaarden read and accept them.

I have read the Privacy Information and acknowledge it.

I have read the Withdrawal Information and acknowledge it.

Estimated Order Value*0,00 €

Diagnostiek order on invoice.